Threading the Abortion Needle

It’s gotten pushed to the background this last week in all of the uproar about town hall protests and death panels, but the question of whether a public option would include abortion coverage remains controversial for a fair number of Catholics and evangelicals who are otherwise supportive of health reform.

Before Congress broke for recess last week, the House Energy and Commerce Committee approved an amendment by Rep. Lois Capps (D-CA) that sought to achieve a compromise. It would allow coverage of abortion under the public plan, but only from dollars paid in premiums, not through federal funding. And it would also allow–but not require–private plans in the exchange to offer abortion coverage, again not using federal dollars. But because premiums for low-income individuals in the public plan would be subsidized with federal dollars, abortion opponents have protested that the compromise still allows government funding of abortion.

One solution would be to have the subsidies take the form of vouchers to individuals rather than government checks to specific plans. If individuals choose plans that cover abortions, that’s their choice. Pro-lifers wouldn’t complain if the government gave a general tax cut, which an individual then used to pay for an insurance plan that covered abortion. It’s like when the government gives a Pell grant to someone who then uses it at a Catholic College. That’s not viewed as a direct subsidy of a religious entity — which would be a violation of separation of church and state — because it is first and foremost aid to a person not an institution. Let’s apply the same principle to health care aid.

Waldman’s proposal has already gathered tentative support from some Catholic corners. The second proposal, from Slate’s Meredith Simons, is more out-of-the-box and controversial, but has the added benefit of potentially defusing the abortion issue overall. The solution? Privatize abortion coverage by creating a private abortion fund to pay for abortions for those who can’t afford them and don’t have insurance coverage for them. Simons points out that reproductive health charities raise around $1 billion each year from individuals and foundations, far more than would be needed to provide abortion coverage to low-income women.